Evaluation of Acute Pancreatitis in Patients Receiving Doxycycline Therapy: A Prospective Study

TL;DR

This study finds that doxycycline can rarely cause acute pancreatitis, with symptoms resolving after stopping the drug and careful monitoring.

Contribution

The study provides the first prospective evidence linking doxycycline therapy to acute pancreatitis and identifies prolonged treatment duration as a potential risk factor.

Findings

Seven out of 124 patients (5.6%) developed acute pancreatitis during doxycycline therapy.

Affected patients had a significantly longer treatment duration (12.3 days) compared to non-affected patients (10.6 days).

All cases resolved with conservative management and no mortality was observed.

Abstract

Background

Acute pancreatitis is an inflammatory disorder of the pancreas with diverse etiologies, among which drug-induced pancreatitis (DIP) represents a rare but clinically important subset. Doxycycline, a widely used tetracycline antibiotic, has been infrequently implicated as a causative agent in isolated case reports, leaving the true incidence and risk factors unclear.

Objective

This prospective study aimed to evaluate the incidence, clinical characteristics, and biochemical profile of acute pancreatitis in patients receiving doxycycline therapy and to identify potential associations between patient characteristics, duration of therapy, and disease occurrence.

Methods

This 24-month prospective observational study was conducted at Khyber Teaching Hospital, Peshawar, Pakistan. A total of 130 adult patients receiving doxycycline therapy were enrolled, of whom 124 completed follow-ups. Baseline pancreatic, hepatic, and renal enzyme profiles were assessed before therapy initiation, and patients were followed weekly for clinical symptoms and biochemical parameters. Acute pancreatitis was diagnosed according to the revised Atlanta criteria. Data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2018; IBM Corp., Armonk, New York, United States). Quantitative variables were expressed as mean ± SD, and categorical variables as n (%). Associations were evaluated using chi-square and t-tests, with p < 0.05 considered statistically significant.

Results

Among 124 participants, seven patients (5.6%) developed acute pancreatitis confirmed by biochemical and radiological findings. The mean latency to onset was 8.1 ± 2.3 days. The mean duration of therapy was significantly longer in affected patients (12.3 ± 2.1 vs. 10.6 ± 3.1 days; p = 0.03), while no significant associations were observed with age, gender, or BMI. All affected patients presented with classical symptoms, elevated serum amylase (422 ± 118 U/L) and lipase (698 ± 210 U/L), and recovered completely with conservative management. No mortality occurred.

Conclusion

Doxycycline-induced acute pancreatitis, though uncommon, is a clinically relevant adverse event with favorable outcomes upon early detection and drug withdrawal. Prolonged therapy beyond 10 days may increase risk, underscoring the need for clinical vigilance and patient monitoring during treatment.

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